Robert M. Ziegler still remembers the day he lost confidence in Connecticut’s emergency medical response system.
A paramedic, Ziegler had raced to the aid of a heart-attack victim and stabilized the woman for her hospital transport. All was going according to plan – until he kept waiting for the ambulance to arrive, and time slowed to a crawl.
“I’m in the living room with her for 28 minutes,” Ziegler recalled, “and it took me 14 minutes to get there. That’s almost 45 minutes in total time. I’m sitting there thinking, ‘This is a broken system; there has to be a better way to do this.’”
The 62-year-old woman survived the 2003 scare. But the underlying problem for many ambulance providers remains: a shortage of daytime volunteers to adequately handle calls during regular business hours.
In Connecticut last year, 59 towns had at least one ambulance provider [or mutual-aid backup] that failed to respond to calls in an average time of 8 minutes or less – a nationally-accepted standard for timely arrival, according to reports filed with the state Department of Public Health.
The reports show wide swings in response times – from under a minute to more than hour in some cases. Ambulance providers, who file the quarterly reports with the state, do not adjust times to account for legitimate-delay variables such as “standbys” at crime and fire scenes.
To improve lagging response times, ambulance corps in several towns are hiring paid staff to bolster dwindling volunteer ranks. The volunteer shortage stems from workforce changes such as longer commutes and an increased reluctance by employers to let workers skip out for volunteer duties.
In 2009, the New Milford Community Ambulance Corps added two paid EMTs to work during weekday business hours when volunteer shortages are most prevalent. New Milford made the hires to comply with a state finding of a “pattern of failures” responding to 911 calls – including one incident when a stroke victim waited for more than an hour for an ambulance. Since adding the additional paid staff in January 2009, New Milford’s average response time has dropped to 9.5 minutes – from 12.2 minutes in 2008.
“We’re happy; we’re doing the calls on time,” said Andrew Armstrong, president of the New Milford Community Ambulance Corps.
Rising call volume is another challenge for some of the state‘s 200-plus ambulance providers. Connecticut’s aging population means more 911 calls from residences and more elderly-care facilities generating calls.
The Southbury Ambulance Association recently added paid ambulance staff to handle additional calls related to the town‘s population growth. Southbury’s average response time dropped to 7.2 minutes in 2009, from 8.3 minutes in 2008, while call volume increased.
“This town has grown so much we can’t keep up with the volume,” said Geralyn Hoyt, service chief for the Southbury Ambulance Association. “You can’t make your citizens suffer, so we added staff.”
“The days when self-employed people could leave work to go handle two or three calls a week are over,” Hoyt said. “Now we get five calls a day. If your business depends on you to answer that phone from 9 to 5 and you’re out on ambulance calls for free, you don’t have to be Thomas Edison or Ben Franklin to figure out something is wrong.”
To meet its new staffing needs, Southbury contracted with a company that Ziegler launched shortly after his 2003 scare. The company, Emergency Resources Management in Portland, now provides staffing for the Southbury, Haddam, New Hartford and Seymour ambulance corps, as well as the Bethel and Stony Hill ambulance corps in Bethel.
“Essentially, what we are is a temp agency, a staffing agency,” Ziegler said. “The communities are suffering because more people are working and no one is at home to volunteer.”
“The problem that day [in 2003] – and the problem that still exists now – is that there were not enough volunteers available to run that ambulance” Ziegler said.
Ziegler’s firm is one of two in Connecticut supplying paid emergency workers to ambulance corps with long volunteer traditions. The other company is VinTech Management Services in Torrington, which started in 1998, and now contracts with several Danbury-area communities, including New Milford, Brookfield, and Redding.
Called MSOs [Management Service Organizations], the firms are among the first in the country that are helping transform small volunteer ambulance corps into modern hybrids that combine old-style volunteer tradition and 21st century resources.
The firms provide EMS personnel who work out of local facilities and use local vehicles. In many places, local volunteers still handle night and weekend calls, though MSOs will provide staff for those hours also.
The MSOs appeal to many ambulance providers that are reluctant to give up insurance revenue from ambulance runs and also want to preserve local tradition. Residents like to see town ambulances responding to emergency calls.
“The MSOs do a great job in providing manpower,” said Gary E. Wiemokly, EMS Section Chief for the state Department of Public Health. “The offer a positive solution. The volunteer shortage still exists and is a little worse in the more rural areas, where there used to be folks readily available to volunteer.”
Connecticut’s 200-plus ambulance providers include several different models. They include volunteer fire and rescue groups, municipal fire departments, commercial ambulance companies, hospital-based corps and private industrial corps.
Towns that privatize ambulance services enter into contracts based on demographic makeup, level of coverage and number patient transports. In 2008, West Hartford paid American Medical Response Inc. a yearly service fee of $227,705. AMR, the nation’s largest private ambulance provider, has Connecticut operations in the Bridgeport, New Haven, Hartford and Waterbury areas.
Connecticut’s aging population will continue to drive demand for paid EMS staff, according to the U.S. Bureau of Labor Statistics, which projects a 14 percent increase between 2008 and 2018. The national growth rate for paid EMS staff is projected at 9 percent.
“It’s becoming a bigger and bigger issue,” Ziegler said, “especially in this economy.”